Telehealth promises lower costs, more access

Whole generations of Americans have no memory of a time when doctors routinely made house calls. But with the rapid acceleration of telehealth and telepharmacy technologies — and their increasing use by physicians and pharmacy providers — the virtual house call is bringing remotely delivered health services to thousands of patients where they live, work and shop.

Fueled by a host of powerful factors — including urgent cost-cutting efforts by government and employer-based health plan payers; a shortage of primary care physicians; the difficulties in serving millions of patients in remote locations who lack access to doctors, hospitals, clinics and pharmacies; and the explosion in new mobile health apps and other technologies — telehealth solutions are popping up across the United States. More and more physicians and pharmacists are turning to those technologies to deliver spot diagnoses, counseling and prescription services to patients in their homes or other remote locations via computer screen or kiosk.

"Receiving remote medical care is becoming more common as technologies improve and health records get digitized," noted the MIT Technology Review in June.

InMedica, a division of research firm IHS, predicts that 1.8 million patients worldwide will access health and wellness care via electronic and video links by 2017. That will mark a six-fold expansion of telehealth services over the next five years, according to the firm.

Among the reasons why, InMedica reported, is demand from health providers who "want to use telehealth to increase ties to patients and improve quality of care," and the critical need to lower health expenditures with more cost-effective ways to reach patients.

"Readmission penalties introduced by the U.S. Centers for Medicare and Medicaid Services are driving providers to adopt telehealth as a means of reducing [hospital] readmission penalties," noted InMedica. "Faced with increasing healthcare expenditure, other governments … are also promoting telehealth as a long-term cost-saving measure."

A report last year from Towers Watson predicted that more than 25% of U.S. employers would offer telehealth options to their workers by mid-2013. And new research from Kalorama Information indicated that expenditures for telehealth and mobile health technologies more than doubled over the past five years, from $4.2 billion in 2007 to more than $10 billion in 2012.

The American Telemedicine Association estimated that there are already some 200 telemedicine networks in the United States, and said those networks connect patients with more than 3,000 provider sites.

ATA defines telemedicine as "the use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status.

"Telemedicine includes a growing variety of applications and services using two-way video, email, smartphones, wireless tools and other forms of telecommunications technology," the industry group noted. "Starting out more than 40 years ago with demonstrations of hospitals extending care to patients in remote areas, the use of telemedicine has spread rapidly and is now becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies, private physician offices, as well as consumers' homes and workplaces."

John Sculley, former CEO of Apple and former president of PepsiCo, is a board member of MDLive, one of the nation's top providers of telehealth services. He cites the "disruptive innovation" and "transformational" nature of remote-site delivery of diagnostic, counseling and prescribing services. Telehealth, he said, "will allow everyday Americans to use video technology for better access to doctors and better control of their healthcare needs."

Sculley predicted recently that the nation's vast and unwieldy healthcare system will soon see a shift, fueled by technological innovations like telehealth, mobile health and wearable health monitors, to "major, big branded services, because we're moving to an era of high-deductible insurance, where consumers are going to make choices and spend their own money."

"Health care is having a game change with disruptive innovation, letting the consumer take more of a role in their own health," Sculley asserted. "We're in the early days of the consumer era in health care. We've got to make the patient excited about their wellness, about their health."

Examples of the exploding use of telemedicine and mobile health applications among pharmacies, hospitals, physician groups and other health providers abound. Among recent innovations occurring around the United States:

Walgreens' Take Care Health Systems is collaborating with Blue Cross and Blue Shield of North Carolina and telehealth solutions provider American Well to provide remote-site health services. The pilot program, called OnlineCareNC, allows BCBSNC employees to receive a telehealth consultation from a Take Care nurse practitioner, health coach or nutritionist via two-way video, secure text chat or phone. "During each online visit, Take Care healthcare providers will be able to review the employee's available clinical information, discuss symptoms and recommend follow-up care, as appropriate, to established patients," noted the companies in a joint statement. "The telehealth system will automatically create a complete electronic record of each online visit, supporting continuity of care and collaboration among the providers caring for employees." Walgreens group VP Peter Hotz said: "Innovative approaches, such as telehealth, and specifically OnlineCareNC, enable us to expand our reach and positively impact more lives, ultimately driving better health outcomes while also reducing costs for patients, businesses and payers";

Rite Aid has expanded its NowClinic Online Care offering to 58 more of its pharmacies in Maryland, Massachusetts and Pennsylvania, allowing patients in those stores to access doctors and nurses via secure, "virtual clinic" consultations;

Beginning July 1, insurance giant Cigna and its new telehealth partner, MDLive, began offering eligible health plan members access to online video or telephone consultations with physicians 24 hours a day. "It's cost-effective and convenient for minor illnesses, such as allergies, pink eye and sinus infections," said Jackie Aube, the insurer's head of product development. Cigna has offered its members reimbursable "virtual house calls" nationwide since 2007 through RelayHealth's webVisit consultations via an online, structured interview format between patients and physicians working under contract with the insurer, and will continue to offer that service as well; and

In partnership with SoloHealth, Safeway is rolling SoloHealth Station kiosks into nearly 700 of its supermarket pharmacies nationwide, providing its customers "access to free health screenings, personalized assessments and valuable health information." SoloHealth unveiled plans to expand its FDA-approved SoloHealth Station health-and-wellness digital kiosks to more than 2,500 store locations by mid-2013 on the way to more than 4,000 locations by 2014.

Despite these advances, all is not smooth sailing. Mario Gutierrez, executive director of the Center for Connected Health Policy, noted that the advance of telemedicine is still plagued by a lack of uniform national regulatory standards governing the use of remote-site and mobile health applications state to state.

"Every state has its own unique set of telehealth policies," Gutierrez noted in a report on state-by-state telehealth laws and reimbursement policies issued in June. "In some cases we even discovered inconsistencies with policies within the same state."

What's more, while "44 states have some form of reimbursement for telehealth in their public program," the report noted, six states — Connecticut, Iowa, Massachusetts, New Hampshire, New Jersey and Rhode Island, along with the District of Columbia — do not. And only seven states — Alaska, Colorado, Kansas, Minnesota, New York, Utah and Washington — offer "some form of reimbursement for [remote patient monitoring] in their Medicaid health programs."

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